Good News: Newer Medicines Actually Help Stop Smoking

Today (May 31) is World No Tobacco Day and a good time for all smokers to sit back, take a deep breath and think about quitting their habit. I’m very happy to report that your family doctor finally has a couple good prescription options for you. The usual Rx for years had been a varying combination of counseling therapy + nicotine patches/gums + bupropion pills. It worked for some people but wasn’t hugely effective. Then a few years ago came a new medicine, called Chantix in most countries (generic name is varenicline) and I’ve had more success with this medicine than anything else I’ve tried in my ten years of family medicine practice. There are many studies showing how well it works, including a 2008 Public Health review which said varenicline helped triple your odds of quitting smoking, and at 6 months after quitting 33% were still smoke-free; those are impressive numbers for such an addictive drug. And just this month yet another study came out that shows its effectiveness. Here’s the full abstract, a bit dry to read but important:

Background: The use of varenicline tartrate alleviates postquit withdrawal discomfort, but it also seems to reduce the “reward” associated with smoking. The current treatment schedule, which commences 1 week before quitting, relies primarily on the first mechanism. We set out to determine whether increasing the prequit medication period renders cigarettes less satisfying and facilitates quitting.

Methods: One hundred one smokers attending a stop-smoking clinic in London, United Kingdom, were randomly allocated to receive varenicline for 4 weeks before the target quit date (TQD) or to receive placebo for 3 weeks before the TQD, followed by varenicline for 1 week before the TQD. In both groups, standard varenicline treatment was given for 3 months after the TQD. Measures included smoking satisfaction and smoke intake before quitting, urges to smoke and withdrawal discomfort after quitting, and sustained abstinence from the TQD to 3 months.

Results: Varenicline preloading reduced prequit enjoyment of smoking (P = .004) and smoke intake (P < .001), with 36.7% of participants reducing their cotinine concentrations by more than 50% (reducers). Varenicline preloading did not affect postquit withdrawal symptoms, but it increased 12-week abstinence rates (47.2% in the varenicline arm vs 20.8% in the placebo arm, P = .005). The effect was particularly strong among the reducers in the varenicline arm (66.7% in reducers vs 22.6% in nonreducers, P = .002). Varenicline preloading was well tolerated.

Conclusions: Although several issues remain to be clarified, varenicline preloading can generate a substantial reduction in ad lib smoking and enhance 12-week quit rates. Current treatment schedules may lead to suboptimal treatment results. Trials with longer follow-up periods are needed to corroborate these findings.

The bottom line here is that impressive 12-week improvement of 47% of medicine-takers still not smoking, versus only 20% of the placebo-takers still abstinent.

Of course, these medicines are prescription-only because they do have side effects, and they may not be the best option for everyone. But they varenicline was a big advance in medical therapy, and I urge all smokers — or loved ones of smokers — to talk to your family doctors about these newer options.